It seems that the latest fix in the search to repair the broken mental health in the U.S. is to dial the primary care physicians into the equation. The thinking is that they are “first responders” and can flag issues, talk with patients, provide treatment options and act as both helper and gateway. David Satcher, former Surgeon General, and Patrick Kennedy have included this concept as a prominent component in their recently announced collaboration to improve the mental health system:

“We need to improve access to high quality care to provide the best outcomes for our brothers and sisters seeking recovery from mental illness and substance abuse. More than half our nation’s counties do not have a practicing psychiatrist, psychologist or social worker. We must increase the number of mental health professionals across the country, but we must also encourage primary care providers to make mental health part of their charge. Family practitioners are often in the best position to intervene early and improve mental health outcomes before conditions become worse.” http://www.usatoday.com/story/opinion/2015/02/04/mental-health-satcher-kennedy/22764289/.

This sounds like a great idea. I had heard of it prior to the Satcher-Kennedy announcement and in fact recently went to an initial consultation with a highly respected primary care physician in Atlanta with just this in mind.

I explained to her that I was having severe anxiety, but had already taken the psych med route and did not want to repeat it. To make the point that I had been through the med mill, I read her the following excerpt from Southern Vapors:

“Other than a couple of six month periods when I decided to stop taking medication altogether, I was on mood-altering drugs from 1980-2010 (yes, that would be thirty years). Sometimes it was a single drug, often two in combination and once it was a combination of four. I kept meticulous records (that was the lawyer in me), so I have the complete list from all thirty years. The traditional medications that I took were prozac, wellbutrin, effexor, phen-fen, depakote, celexa, serzone, xanax, paxil, ativan, klonopin, zoloft, cymbalta, topomax, lamictal, geodon, hydrozine, seroquel, phenergan, flexeril, vyvance, trazidone, provigil, lithium, valium, lexapro, resperidone and adderall.”

I looked up at her after I put the book down, and she said, “Have you tried Abilify?”

I wanted to hit her.

I have a follow up appointment with this doctor in a week, and I haven’t decided whether to go, change doctors (again), or try to educate her. If primary care physicians are going to be the front line on mental health, they actually need to know something about it. In my experience, few do. In their ignorance, they can do active harm in so many ways that it is hard to count them. Many already prescribe psych meds at the drop of a hat. I remember being offered a Xanax prescription by my gynecologist years ago. I said no, since at the time I had a psychiatrist in tow and figured a divide and conquer approach made more sense: brain to the psych guy, nether regions to the gyn. The worst, I think, is that we are taught to trust these doctors, and we hand them authority that they don’t deserve.

My take on this is beware of primary care physicians doling out mental health advice until we have a tested and proven system in place to educate them not only on the existing (or non-existent, depending on whom you believe) medical science of mental health, but also on the intricacies of the patient relationship when discussing mental health issues.

I always did want to post this out-take from Southern Vapors. I liked it, even though my editor said it needed to come out of the book. She thought it was irrelvant. For anyone who knows me well, it actually says alot.

“Temporarily embarrassed.” That’s an old-fashioned phrase that perfectly describes how I felt about my situation in the summer of 2010: back in Atlanta, impoverished, one step away from going on the dole with my mother, rejected by prospective employers at every turn and living in an apartment with uneven floorboards and no thermostat.

I love this particular usage of the word “embarrassed.” It was often used in the Victorian novels I read as a teenager, the very same novels that introduced me to “the vapors” (only spelled “vapours” in the English way). The typical context was when a young dandy found himself “temporarily embarrassed” at the gaming tables, that is, out of money or credit, but sure to re-establish himself in short order.

As distraught as I was by my feelings of “temporary embarrassment” and worries about being jobless, my distress was often offset by moments of levity, courtesy of Suzy Marmalade.
I remember one day in that same summer of 2010 being on my way out of town for a quick trip to Hilton Head, South Carolina.

I decided that I had better fill up on gas and check the oil in my car. I pulled up to the pump, got the gas going and, in Suzy mode, made an instant assessment. “I don’t know how to open the hood and I have no idea how you check the oil on this car (having owned it for a year and a half). There’s a twenty-five-year-old guy in an Ole Miss T-shirt sitting over there reading a book; let’s rock n roll.”

I walked over to the guy and said, “How would you like to meet the last of a dying breed?” He looked up, made his own quick assessment, and answered, “What do you need help with?” I told him and he followed me over, asked me to pop the lid on the hood. Up until then his expression had been neutral, but I saw his lip begin to curl when I told him that I thought there was a latch in the car that popped the hood because I had pulled it by mistake before, but I didn’t remember where it was. He found it, popped the hood, propped it up and started checking the oil. As he went along, he gave me a little lesson, explaining where the dipstick was, how you pull it once and wipe it, then check it again—all things I’d done years ago, but somehow allowed to fall out of my memory.

Not “somehow.” It was Suzy, banking as always on the “temporary” part of “temporarily embarrassed.” Surely the day was just around the corner when once again I would have someone taking care of the details for me, right? So I smiled inside while the kid gave me a lesson he thought I needed, and secretly tuned him out. In truth, however, I’m not a total idiot and it actually was a little interesting, so I listened with one ear and afterwards I once again knew how to check the oil in my car.

I used to belong to a writer’s group ’til I joined a therapy group that caused a scheduling conflict (close call as to which is the better therapy, but the therapy group won out). We did great exercises at the writer’s group meetings, like the one where we wrote down four words, passed them to the left and that person had to make a story using the the words in ten minutes. I was cleaning house tonight and came across the piece I wrote with my four words (to the best of my recollection, my four words were red, diamond, turtle and feral). On re-reading the story, I liked it, so here it is. Maybe someday I’ll make a longer story out of it.

The moth, unsuspecting, circled the red flame. When it ignited, Jezebel sighed–regrettable that she had lost her one source of entertainment.
Being confined like this was wearing on her, she was no Nelson Mandela, and while torture so far had not been part of the picture, random scenes of violence popped into her head without the ballet of the moth to distract her. She heard the growl of a feral cat nearby, escalating to a steady whine–she amused herself by the thought that perhaps it was giving birth–if she had to suffer, so should the rest of God’s creatures. Her belly grumbled, and she felt a diamond stab of hunger. She was shaking again, and reaching for her crutch, stumbled at turtle’s pace across the room to the table where her negligible meal had been laid. Good thing she had gained a few pounds before they caught her, they had certainly evaporated by now.

Sticks and stones may break my bones but words can never hurt me. What a lie. A whistling in the dark, wishful thinking, lalalalala with my fingers in my ears bold-faced lie. Who among us has not been hurt by words?

So here’s a biggie. I was surfing the Net, looking for mental health news (the dearth of forward motion in that regard a topic for another day). I saw a Daily Beast blog on the recent shootings at the Washington Navy Yard and I as I was reading along, I was stunned to see a reference to a federal gun law that prohibits the sale of guns to people who have been “adjudicated as a mental defective.” I stopped dead in my tracks, read no further and started researching whether it could possibly be true that we have a law in this country, right here, right now, that refers to a person who is mentally ill as “a mental defective.” It took me all of thirty seconds to pull up the FBI Fact Sheet for the National Instant Criminal Background Check System and maybe ten more to retrieve 27 CFR § 555.11 which provides definitions for regulations under the Bureau of Alcohol, Tobacco and Firearms (now called the ATF).

Yes, Martha, we in the United States of America do in fact have a justice system that refers to people as mental defectives. Under the ATF regulations, they are disqualified from possessing a firearm. The regulation defines a mental defective as a person who has been determined by lawful authority, “as a result of marked subnormal intelligence, or mental illness, incompetency, condition, or disease [to be]: (1) a danger to himself or to others or (2) lacking the mental capacity to contract or manage his own affairs.”

Fine, no problem with the me that people who are enormously unstable or unable to think clearly can’t own a gun. But let me tell you, calling such people “mental defectives” in big black letters as the law of the land turns my stomach. I feel physically ill every time I read it. How do we expect to get past stigma in this country if even our laws carry it imbedded in their text?

I decided to research a little more. I found a comment in testimony from NAMI (the National Alliance on Mental Illness) in 2007, in the wake of the Virginia Tech tragedy. Part of a single line in the testimony is devoted to the pejorative nature of the language: “First, as a threshold consideration, the term “adjudicated as a mental defective” is stigmatizing….” No more is said on the topic nor did I find other commentary about it. NAMI describes itself as “the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness.” Then get your ass out there and tell someone out loud and in a way that everyone can hear and will not easily forget or shove aside that people with mental illness are not defective and do not appreciate being referred to as such.

Yes, words can hurt me, and being called defective surely does. Not only am I hurt, I am outraged for myself and for every other person who has ever, does now, or will ever suffer from mental health issues. If I have to dance naked (well, maybe not naked) on tables to get people’s attention, I will do it. This needs to stop.

This post is emmis, as they say in Yiddish. That means the absolute, unvarnished truth, the kind you can take to the bank. The word came to me from the fogbank of my youth, so I checked out the meaning here – http://www.asinine.com/essays/yiddish.html. I highly recommend a look if you have any curiosity about Yiddish expressions.

But I digress.

I often natter on about the overmedication of America, and the need for reflection and talk therapy instead of pills. I also natter on about how recovery is not a straight line. For me it has been sort of like this:

or, if I am feeling less positive, like this:

Recently two things were brought home to me yet again. One, how profoundly psychological my particular issues are, how fruitless it would be to try to medicate them away – like telling a teenager who has broken up with her first boyfriend to take an aspirin. The one does not in any way address the other.

The second thing that was brought home to me is that I can still fall far and hard and fast. I am in no way immune from the frantic, desperate emotions of my past. I may get a grip on my issues faster, and I may have more mental health to draw on to stabilize me, but I can still fall into the abyss.

Which I did two weeks ago. My mood had begun swinging suddenly and violently between being okay one minute and the next feeling a despair so profound that it seemed that I would never escape. I couldn’t for the life of me figure out what was going on. A friend suggested hormones, so I had my thyroid checked for the hundredth time. And for the hundredth time, it was stubbornly healthy (poo, poo, poo, as they also say in Yiddish). No easy fix there. At a certain point I threw all of my learning about myself out of the window and started researching new pysch drugs (which anyone who has read my stuff knows I don’t believe in for me). I left a message with the last meds doctor I had seen before I gave all that up, wanting to make an appointment to see if there was “anything new on the market.” (Ha! that tells you something right there.) Even my therapist, who knows my history of being resistant to medication, suggested trying the drug route to see if there was something out there for a quick boost. I think we were both shocked and worried that I had plummeted this far this fast. I would have killed right then and there for a drug, something to take me out of my misery. It is poetic justice that the meds doctor’s office never called me back. There is no help for me in that corner.

It’s a long way around to the punch line of this story, but it’s worth it. What was really happening is almost not credible, except that it’s the truth. Follow closely, because it’s a serpentine path from A to D. Pay attention to how many red flags I ignored along the way that were tipoffs that my thinking was out of whack in a way that would likely burn me. For my own edification, I have put an “F” after every flag that I now see in retrospect.

About four weeks ago, I came up with a plan to spend a week out of every quarter working in my law firm’s New York office. I have a big birthday coming up and I had been thinking about my life, about how much I miss the pace of a bigger city and big city “doings.” I had lived in New York for a year when I was younger, so it still seems a bit like home, plus I have plenty of friends and family there. I thought the notion of working there for a week was a great one – I wouldn’t have to take vacation time, I could go work in the Big City (visions in my head of Marlo Thomas in That Girl), and have fun and celebrate my birthday at the same time. I could fly up cheaply and rent a room on line, also fairly cheaply, and the time line was short enough not to be a big disruption in my routine (therapy, standing Trivia night, pet responsibilities, etc.). It seemed like a win win.

The firm was most gracious and after a few administrative emails back and forth, we got it all set up. I would have a desk and an assistant as needed, and access to a printer and copier. I was thrilled! I told some friends and they were all excited for me. I made plans with New York friends for the day and night of my birthday. I booked my ticket. I looked for rooms to rent (a fun way to find housing out of town; I used the www.airbnb.com website and loved it).

Then I hit a bump in the road. I didn’t notice it at first. I was a little worried to tell my mother about this plan (F). I knew instinctively that she wouldn’t much like it (F), that she would take it personally that I was not staying in town to celebrate a big birthday with her. But I mentioned it casually at dinner one night, and at least got over the hump of telling her. Her reaction was subdued (F), and she mentioned something about that being my birthday week. I justified myself (F) by explaining that the previous week was Labor Day and the next week I had a conflict. I was glad that she didn’t ask what the conflict was (a TV interview about Southern Vapors), since she would have disapproved (F).

I kept looking for rooms on airbnb and narrowed it down to a couple. I emailed the host of one asking a few questions, noting that this was all a little premature, as I wasn’t ready to rent yet. (F- there was no good reason not to go on and book it.) I noticed that I was dragging my feet a little, not calling any more friends or family in New York to tell them I was coming, not booking the room, not looking up events and activities that would be going on in the city during my stay (F). I noticed that for some reason, I wasn’t so excited about the trip any more, a trip that two weeks before had lit me up like a candle (F). I didn’t pay much attention to my curious resistance, because I had bigger things to think about. At this exact moment, I fell off the wagon into my eating addiction (F).

I talk about this occasionally on the Southern Vapors Facebook page, and the lack of response makes me wonder how many people really get it about an eating addiction. That it shares the qualities of the more well-known addictions, like drugs and alcohol, including the guilt, shame, pain, self-hatred and disgust that any addict inflicts upon him or herself. For anybody who doesn’t get that about food, just substitute “Scotch” or “Crack” when I say food, and you’ll get the idea.

This binge was textbook, in that like every other binge in my life, the more I ate, the worse I felt and the more I beat myself up. The more I beat myself up, the more I ate to comfort myself. Addiction is not called a cycle for nothing. I ate to excess except for the times when I didn’t eat at all, when from Monday morning until Thursday night for two weeks running, I had nothing but three low calorie protein shakes a day (except for the first day, when I only had two). The plan was to segue into a “diet” of some sort, only that didn’t happen. The segue was into uncontrolled and uncontrollable bingeing, but only at night. Daytime was controllable, but at night I would eat from the time I got home til the time I went to sleep. I was getting increasingly uncomfortable physically, and mentally it was killing me. I was terrified that I wouldn’t be able to stop.

I wept during my appointments with my therapist. I called my friends and wept to them as well, responding to their concerned inquiries with an understated “I’m not doing very well.” (That’s my code for “pull out the stops, this ship is going down.”)

Everybody was sympathetic and checked in on me often and with great kindness. We all tried to puzzle it out. Was I in such a slump because my ex-mother-in-law was dying? We had been very close, and it did make me very sad when I thought about her impending loss. Was it because my youngest child had gone back to Virginia after staying with me for a month, and I missed her desperately? Of course I did, but to the point of self-destruction? Neither answer seemed quite right. After a couple of weeks of poking around, querying this and that, I casually pointed out to my therapist, “If I keep eating like this, I won’t be able to go to New York.” (FFF!)

She looked at me in amazement and said, “What on earth do you mean?” I said, “Well, I’ll be too fat to go,” as if it were the most obvious thing in the world. She pointed out to me that realistically, I was leaving in three weeks and it wasn’t enough time to gain but so much weight. It’s not like I would be unable to fit in the plane seat, or walk down the street, no matter how much I ate between now and then. So what was I really talking about?

She told me what she thought, which turned out to be exactly right. It was hard to credit it because the explanation seemed so far out, but it had the ring of truth the minute I heard it and the immediacy of my change from melt down mode back to stable lady lawyer was proof positive (hours, not days, as if a switch had been thrown).

Here’s the deal. My early environment, training and experience all have left me with a deeply held belief that I am caught in a Leviathan struggle with my mother, a competition that is as fundamental to my existence as breathing. I believe at a primal level that this competition will be, can be, survived by only one person. I believe with every fiber of my being that my mother will be that survivor each and every time, not me, not ever, not once. That always and forever, in any contest between us, she will be the winner. That in fact was how things worked out during my young years, which explains why I got stuck there for the next forty. Right here, right now, at age 59.999, in the Year of our Lord 2013, my trip to New York is a part of the contest. Who is fairer? Who more sophisticated? Who knows the latest happenings better? Who is smarter? Who is kinder? Who is clever enough to dream up a working trip to New York? Who is deserving enough to go there and experience what the city has to offer? These are all fields upon which my mother and I play, at least in my mind. (“Mirror, mirror on the wall…”) In fact, in my mind, every interaction we have is a field on which we compete. And on which I lose, either by combat, by acclamation, by default or by self-sabotage.

I had to lose this latest bout staged as a trip to New York like all the others. The question was how? By elimination, the answer was self-sabotage. My mother is almost 89 and doesn’t work; she clearly wasn’t haring off to New York by herself, so combat was out. No one else was saying that it should have been she not me to go, in fact everyone I told was really excited for me. Acclamation was out. She wasn’t going to win this one by default—I was the one going on the trip. So the only thing left to make my construct work was to take myself out of the game. Which I proceeded to do early, fast, and viciously, to the point that checking back into a mental hospital did not seem outside the realm of possibility. Food was the perfect vehicle for more reasons than I could count, principal among them that it is the precise point of intersection between my mother’s addictive behaviors and my own.

It is now four days after my revelatory experience. I won’t say that I’m back to 100%, because I am not. Understanding the problem is half the battle, but there is still the other half to fight. There is still the deconstruction of the myth that I am in an ongoing contest with my mother for my survival. I have believed that for far too long to let it go so fast. I do now see clearly that the fight is an old one and that on today’s battlefields I am fighting without an opponent, or at least one whose power has been vastly diminished. It’s like being triggered by a hologram, but triggered nonetheless.

To anyone who says, “Forget the past, why can’t you just move on?” I recommend this story. To anyone who says that medication should be the court of first resort, I say, “Not always.” To anyone who says that their recovery should be fast and linear, I wish you all the luck in the world. To anyone who would like to poke holes in this tale, I say that truth is far and away stranger than fiction. And to anyone who says that the mysteries and the revelations of this life are not worth it, I say that they are to me.

People in the South didn’t talk much about money when I was growing up, at least not the cultured ones. It was considered a sign of bad breeding, and that was unpardonable. Fast forward to the twenty-first century; boy did that change. As we got into the late months of 2010, people had been hurting for a while, and I started seeing articles about psychiatrists overloaded with pleas for help from relatively moneyed people, because their losses–job, investments, lifestyle–were pushing them to seek help with despair, hopelessness, depression and the other usual suspects. It seems to me that loss is loss once you’ve stepped up a certain distance from subsistence living, and the degree to which one is unprepared to accept loss is the measure of the difficulty of recovering from it. It has been my observation that many well-to-do people (read “Suzy Marmalade”) are not prepared for financial loss—not in the playbook, can’t happen. So the recovery is hard. I have also observed that our society is not predisposed to feel sympathy for people of privilege except under rare circumstances, like the Lindbergh kidnapping or the Kennedy assassinations, so there is not a lot of support, public or private. Having been both privileged and without means, I can say that I understand that lack of sympathy—people of means are insulated in a way that takes away a whole dimension of worry, and I can see a person without means thinking that there is justice in the failure of the moneyed, let them have a taste, just a taste of what the real world, the one without a safety net, feels like.

On the one hand, it feels like crap. On the other hand, it feels raw, liberating, real and comforting–a person the same as everybody else, not a person apart. Given the choice, what would you pick?

I am having a bad week, and it is getting worse. By “worse,” I mean a persistent pit in my stomach, dark thoughts of doom, a deep and abiding desire to consume an entire chocolate cake (the one at Whole Foods with the ganache and the raspberry filling) and an ennui bordering on death itself. It used to be that a downturn like this would gain its own momentum, that the worse I felt the more scared I would get, and the bottom would fall out overnight, launching me into a spiral that would take six months or more to exhaust itself. I still have that capacity, the capacity to take a perfectly normal dip in mood and turn it into a crash and burn, overlooking the possibility of tapping the brakes or turning the wheel into the direction of the skid.

Not this time, baby. I may still have the capacity to pack the suitcase, but I no longer have the willingness to take the trip. I finally have enough perspective to step back and look at the course of my life and know that there will be an end to this period, just like there was to the time before and the one before that. There is no denying that I feel like shit, that my mood shifts are so abrupt that they are giving me whiplash and I am Scared with a capital “S.” It won’t last forever and it won’t kill me. It’s a royal pain in the ass and I wish I didn’t have these proclivities, but I do. So let the bad times roll; the sooner I stop fighting them, the sooner they will pass through and be gone.

How odd that these bad times are probably critical to my efforts as a mental health advocate. They are the single thing that make what I have to say on the subject of mental health believable and relevant. A couple of times I have gotten far enough out into “recovery” that I started to forget what the bad times really felt like. Then I had to dig deep to talk to people about their own troubles, because I couldn’t really call mine to mind any more, not with any degree of immediacy. And when I am telling my story to try to help someone who is depressed or bipolar or anxious, you had better believe I want to be in touch with my own struggles. We all know who has been there and who hasn’t, and there is no substitute for the connection to someone who has been in the trenches.

It’s rather interesting to hold both things at once, recovery and struggle. I would even go so far as to say that it is fulfilling. A wise woman used to correct me every time I said “either…or” and remind me that most things are “both…and.” And so it is with the bad times. I think peace will come as I integrate them into my life, instead of trying to cut them out like a sick calf from the herd.

What are the things that we still don’t talk about AT ALL?
I have thought of a few. Care to add?

1. Severe mental illness, like schizophrenia. We have cracked the door on depression, anxiety and bipolar, those have become household words. No one, not even the “mainstream mentally ill,” wants to talk about the real dark side.

2. Cutting. Drug abuse, alcoholism, anorexia, bulimia, gambling, etc. are all on the table in varying degrees. NO ONE talks about cutting. I have never done it, but I get it, through and through. It would have filled the bill for me in so many ways during my hard times (inflict pain on myself to play out the tape that I am a bad person, inflict pain on myself in order to feel anything at all, release the demons). I can’t explain why I didn’t do it, except for vanity. Maybe that’s the plus side of growing up in a family obsessed by image.

3. The sexual side effects of psych meds. Excellent comments and discussion at http://20commandments.blogspot.com/2012/12/sexual-side-effects-of-medication_31.html?spref=tw Such a poignant comment: “Sanity must trump sex, unfortunately.”

4. The chilling effect of fear of job loss. Many well meaning people advocate in favor of lifting the stigma surrounding mental illness. How is that going to work if you lose your clients, customers, colleagues, etc. if you come out in the open? There are no laws against a client chucking you in favor of a saner model if you show signs of weakness. I was told by an attorney last week (June 2013) that you can’t even disclose cancer, stroke, etc. in the legal profession. Business is so competitive that no one is willing to risk losing a client. If that is the case for “accepted” illness, how are we going to convince people who are suffering from depression, etc., a less acceptable illness, to come forward?

These just popped into my head stream of consciousness. I hope to come up with more and add them as I go.

I recently came across a letter I wrote to my daughter on her college graduation in May 2012. As I re-read it, I was reminded of how happy I am that I didn’t repeat history, that I made a deliberate departure from my own “no talk, no feel” family. I often take myself to task for the things I didn’t do for my children and the imperfect examples I set for them. I don’t often think about what I did right. This is one thing I did right. I have copied part of the letter below, just a paragraph. To most readers, this little paragraph might seem commonplace. For me it was anything but. It makes me happy that with all my flaws, all of my struggles, my addictive behavior, my hospitalizations and the staggering absence of any innate sense of how to be a mother, I still managed to pull a few things off, like this paragraph.

“Well, baby, you’ve done it and you’re ready to launch. You know in your heart what you want and what makes you happy, and don’t you ever listen for a single second to any voice that tells you anything different than what’s in your heart and in your gut. You already have a gift for translating how deeply you care about people into action—keep it up. I know that there is a dilemma when you are told to “do the work that you love” but that work doesn’t look like it will earn enough money for you to do and enjoy the things you desire. I think the important thing is to make sure that there is enough satisfaction in whatever job you do that you enjoy getting up and tackling each new day. I don’t have to tell you that the relationships you have with people are and will always be the most important thing in life and that nurturing and maintaining those relationships will in turn feed your soul; you already know that. I am proud of you all of the time, every minute. Be proud of yourself. I love you.”

I also know that I pulled one other major thing off. Whatever my children thought of me, however worried and upset and disappointed they may have been during my really awful years (2007-2010 if you want to be generous to me, 2000-2010 if you want to be more accurate), nothing I could have ever done or will ever do will match the impact of them seeing me turn my life around. For that I am forever grateful. If there was ever a case of teaching by doing, that was it. Nobody would have wanted my life to go the way it did, but if it had to, at least there were some side benefits to my crashing/burning/phoenix rising progression. Like most things with me, motherhood has not looked like the typical package, far from it, but I suspect that what my children have gained from me has exceeded what they otherwise lost.

What causes addiction? We have discovered that the causes can be many: nature (genetics), nurture (environment), some combination thereof, and other causes. I came by my addiction by virtue of the combo nature/nurture package. I was born sensitive, not necessarily with a gene for addiction, but with a tendency to be vulnerable to hurt, and when hurt came, addiction helped.

I have started on a new book, a novel this time as opposed to Southern Vapors, a memoir. The following excerpt about a mother named Queen and her daughter, Trina, seems to me a nice demonstration of how addiction can come out of a person’s environment, the culture of his or her family of origin.

“You can never be too rich or too thin.” That was Queen’s motto, impressed on Trina daily, or so it felt. Queen was consumed by her size, by the fact that she was large boned and curvaceous in an age when Twiggy’s image was on the cover of every magazine on the newsstands.

Queen’s fashion advisor assured her that Queen’s body was made for clothes, and it was undeniable that she was a showstopper in classic Norman Norrell with matching bag and heels. Queen bought only the best, classics that, with the kid glove care she gave them, would last up to twenty years, fashionable as the day she bought them. It was that damned number twelve affixed to the label that drove Queen crazy. She had gone through a period when she ordered the maid to scissor the label out as soon as the shopping bags arrived from Saks, but after a time the scratchy point left by the scissored tag was more annoying than the label itself. Queen wasn’t much different from a dry drunk, an alcoholic who doesn’t drink but is consumed by thoughts of drinking. Queen was consumed by thoughts of eating, and denying herself so that she was and always would be the fairest of them all.

Trina did not remember a time when Queen’s laser focus on food was not turned on her. She still cringed at the memory of her third grade teacher announcing to the class that Queen had requested that no one give any snacks to Trina because she needed to lose weight. She would never forget the diet doctor Queen had taken her to at fourteen, who gave her shots to make her lose weight and made her stand naked and look a her reflection in the mirror, snapping in her Teutonic accent, “You see dat flab?? You want your body look like dat? No, no, deesgusting!”

Even as a child, Trina noticed an inconsistency in Queen’s apparent mission for Trina to be thin and beautiful. Because whenever Trina did become thin, which was frequently enough in the seesaw world of her weight, Queen’s compliments carried an edge. “Dear, that skirt looks great on you, but don’t you think it’s a little too short?’ “I don’t really think that shade of pink is a becoming color on you.” “Don’t you read the magazines? You’re supposed to wear a belt with that!” At sixteen Queen took Trina to Cadole, the famous lingerie house in Paris and ordered her custom underwire bras at $45 a pop, unheard of in 1969. “Your breasts need the support, you should probably sleep in these, too, or you will sag. You already do a little, at your age.”

What effect did all this have on Trina?

I haven’t written that part yet, so we’ll have to make do with my personal experience. My background, after all, wasn’t that different from Trina’s, and the outcome for me was low self esteem coupled with a built in system for self sabotage as fine and precise as any weapons system ever devised. Add to the mix a complete disconnect from my feelings and that about rounds it out. Addiction, in my case binge eating disorder, was the fuel that kept these personality traits alive and well-fed. I ate outlandish amounts of food to punish myself because I thought I deserved it.
That kept the cycle of low self-esteem intact. If I ever lost weight and began to feel good about myself, I went into extended periods of overeating, lasting for weeks to months, until I had fully sabotaged myself plus extra for good measure. Another way to keep my need for low self esteem well-supported.

I also used food to feel anything at all rather than nothing at all. Because I was so emotionally undeveloped, I had no idea how to identify and process my feelings in a healthy way. But I was desperate to feel something. After all, even I could tell that feelings were pretty much the name of the game when it came to living. So I used my food addiction to make me feel at the most elemental of levels—pleasure and pain; rudimentary, yes, but at least they were feelings. In a parallel fashion, I used the food to numb out the uncomfortable feelings that roiled close to the surface—pain, fear, embarrassment, loneliness. You can eat until you pass out just like you can drink or drug ˈtil you pass out. Arguably it is a more benign, self-loving choice. I did it a lot.

Finally, in a twisted sense, I used copious quantities of food to give myself nurturing that I had missed. What says love more than a delicious meal? They don’t call it comfort food for nothing. Studies talk about the uplifting properties of chocolate. I can’t tell you much about that, only about the end results of dumping vast quantities of sugar into one’s system following periods of semi-starvation—not good to say the least—but the first few minutes were great. It’s a rush just like what I assume a drug rush to be. The withdrawal may be slightly easier, but it’s no picnic.

How did I get better? Lots and lots of therapy, spiritual practice, a steady job and making an extreme effort to learn and practice healthier coping skills. What does “better” mean? For me, no more bingeing ˈtil I am unconscious. Because of the work that I have done and continue to do, I don’t have to fight myself about this any more; the irresistible cravings have been gone for a couple of years. For the moment, “better” means a vast reduction in my intake of refined sugar, candy, baked goods, ice cream, processed foods and the like. It means making an effort to stay connected to people, to reach out if no one has reached out to me and I feel the need for connection. It means adding exercise to my life even when I don’t want to. It means attending my therapy sessions religiously, no matter who is visiting from out of town or what holiday it is. And it means writing posts like this one, which helps me by reminding me of my journey and gives me hope for the future.